Health News : Review on pain relief during labour
Review on pain relief during labour
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admin on 15/03/2012 11:02:00
Scientists at the University of Liverpool have found that there is little
evidence of the effectiveness of non-drug approaches for relieving labour pains
compared to drug-based approaches.
Many different approaches are used to relieve pain in labour, but not all are
supported by strong evidence. The review by Cochrane researchers brought
together the results of 15 previous Cochrane reviews and three non-Cochrane
reviews, including data from 310 trials in total.
To try to distinguish between well-supported and less well-supported pain
relief approaches, the researchers decided to split interventions into three
categories; ‘what works’, ‘maybe works’ and ‘not enough evidence’.
Painkilling drugs given by epidural, combined spinal epidural (CSE) and
inhalation fell under the category, ‘what works’. This category had the
best evidence, but also had more adverse effects including nausea and vomiting
caused by inhaled painkillers and hypotension due to epidural.
The authors classed immersion in water, relaxation, acupuncture, massage and
local anaesthetic nerve blocks or non-opioid drugs as ‘may work’. Although
less well-supported by clinical evidence, these interventions were better
tolerated, with women reporting improved satisfaction with pain relief for all
except massage.
The least supported or ‘insufficient evidence’ group of pain relief
interventions included hypnosis, biofeedback, sterile water injection,
aromatherapy, transcutaneous electrical nerve stimulation (TENS) and injected
or intravenous opioids.
Lead author of the study, Professor James Neilson from the Department of
Women’s and Children’s Health, said: “Women should be told about the
benefits and adverse effects of different pain relief methods, but should feel
free to choose whatever form of pain relief they feel would help them most
during labour. It remains important to tailor approaches to women’s
individual needs and circumstances.”
The study calls for more research on the non-drug interventions that
researchers grouped into the second and third categories. Although generally
safe, for most of these interventions, evidence was based on just one or two
trials.
Fewer than 1,000 women have taken part in trials for each of hypnosis,
biofeedback, sterile water injection, aromatherapy and massage. TENS is popular
and widely recommended by midwives but not by the National Institute for Health
and Clinical Excellence.
“The discordance of views between women, clinicians and guidelines reflects a
poor evidence base and the uncertainty should be resolved by a definitive
clinical trial,” said Professor Neilson.
University of Liverpool
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